CLAFLIN COMMUNITY SCHOLARSHIP, INC
COMMUNITY SCHOLARSHIP, INC. HIGH SCHOOL APPLICATION FORM
President: Lois Steiner Secretary: Christina Hayes Treasurer: Cindy Stueder
NAME OF APPLICANT_________________________________________DATE__________ NAME OF PARENTS_________________________
ADDRESS_________________________
l. School activities and the years of participation (list them): example: FFA-2 years (A)
(E)
(B)
(F)
(C)
(G)
(D)
(H)
2. List awards or honors you have received while in school.
3. What elective offices have you held while in school? (A)
(E)
(B)
(F)
(C)
(G)
(D)
(H)
4. Church activities and the approximate hours of participation (list them): High School years only. (A)
(C)
(B)
(D)
5. Community/Volunteer activities and the approximate hours of participation (list them): High School years only (A)
(C)
(B)
(D)
6. List Work Experience Paid or Non-Paid & Responsibilities/Duties Involved (A)
(C)
(B)
(D)
7. Supply three letters of recommendation. (A) Current High School Teacher (Name
)
(B) High School Teacher or Paraprofessional (Includes Principal and Counselor) (Name ) (C) Employer or an individual other than a family member who is in a position to know you well. (Name ) The letters of recommendation are to be confidential. Envelopes should be prepared by the student applicant for those individuals writing letters of recommendation. Envelopes should be addressed and sent to Community Scholarship, Inc., Box 541, Claflin, Kansas 67525. 8. What career choices are you interested in?
9. List the college or vocational school of your choice. _________________________________________________________________________ 10. Why is this scholarship important to you?
11. What other scholarships and their amounts have been awarded to you at this time? (Scholarships Awarded will not be considered in awarding our scholarships)
12. What is the base cost of attendance of your first year of college? (Include Tuition, Books, Room and Board) $________________________________________________________________________ 13. How much will you be able to contribute towards this cost? $________________________________________________________________________ 14. Approximately how much money can you earn during the summer? $________________________________________________________________________ 15. What other financial help is available?
16. List other children in your family, including ages, who are still living at home or are full time college students.
17. Request the school counselor to send a transcript and ACT scores by April 1st, 2017 to Community Scholarship, Inc., Box 541, Claflin, Kansas 67525. 18. This application must be complete and postmarked by April 1st, 2017. Please mail to: Community Scholarship, Inc., Box 541, Claflin, Kansas 67525. 19. All letters of recommendation must be in the hands of the Community Scholarship Committee by April 1st, 2017. 20. You will meet with the scholarship committee at a time selected by you from posted times for a personal interview on April 30, 2017.
21. In the space below, explain fully, in your own handwriting, your objectives, ambitions, and tentative plans for the future.
I have read all qualifications for these scholarships and certify that all information included is true, to the best of my knowledge, and complete. Student
Date
Student's Cell Number
Student's e-mail (non- school)
*Applicant, please note that all monetary awards will be held until acknowledgement of thanks and proper notification of enrollment is received.
COMMUNITY SCHOLARSHIP RECOMMENDATION FORM CENTRAL PLAINS HIGH SCHOOL - CLAFLIN Applicant:____________________________________is applying for a Community Scholarship. Please give us your candid opinion of this applicant’s qualifications. All information will be kept confidential. Please place in an envelope and return to the Central Plains High School Counselor/Office, or mail to the Community Scholarship Committee, Box 541, Claflin, Kansas 67525. Please return by April 1st, 2017. How long have you known the applicant?___________________________________________ In what relationship have you known the applicant (i.e. teacher, counselor, administrator, employer, friend)?________________________________________________________ What do you consider the applicant’s strongest characteristics and why?
What traits does the applicant have that might impact his/her success in post-secondary education?
Please rate the applicant in the following areas using the ratings: Excellent, Very Good, Good, Fair, Poor, or Not Applicable. Scholarship in your class(es)________________________________________________ Reliability/Dependablility__________________________________________________ Honesty________________________________________________________________ Motivation/Initiative______________________________________________________ Ability to Work With Others________________________________________________ Attendance______________________________________________________________ Ability to Start Tasks Promptly______________________________________________ Ability to Work Independently______________________________________________ Kindly give us further information that you have about this person that will help us to decide upon the applicant’s suitability for this scholarship. If additional space is necessary, the reverse side of this form may be used.
DATE_______________________
SIGNATURE_____________________________
COMMUNITY SCHOLARSHIP RECOMMENDATION FORM CENTRAL PLAINS HIGH SCHOOL - CLAFLIN Applicant:____________________________________is applying for a Community Scholarship. Please give us your candid opinion of this applicant’s qualifications. All information will be kept confidential. Please place in an envelope and return to the Central Plains High School Counselor/Office, or mail to the Community Scholarship Committee, Box 541, Claflin, Kansas 67525. Please return by April 1st, 2017. How long have you known the applicant?___________________________________________ In what relationship have you known the applicant (i.e. teacher, counselor, administrator, employer, friend)?________________________________________________________ What do you consider the applicant’s strongest characteristics and why?
What traits does the applicant have that might impact his/her success in post-secondary education?
Please rate the applicant in the following areas using the ratings: Excellent, Very Good, Good, Fair, Poor, or Not Applicable. Scholarship in your class(es)________________________________________________ Reliability/Dependablility__________________________________________________ Honesty________________________________________________________________ Motivation/Initiative______________________________________________________ Ability to Work With Others________________________________________________ Attendance______________________________________________________________ Ability to Start Tasks Promptly______________________________________________ Ability to Work Independently______________________________________________ Kindly give us further information that you have about this person that will help us to decide upon the applicant’s suitability for this scholarship. If additional space is necessary, the reverse side of this form may be used.
DATE_______________________
SIGNATURE_____________________________
COMMUNITY SCHOLARSHIP RECOMMENDATION FORM CENTRAL PLAINS HIGH SCHOOL - CLAFLIN Applicant:____________________________________is applying for a Community Scholarship. Please give us your candid opinion of this applicant’s qualifications. All information will be kept confidential. Please place in an envelope and return to the Central Plains High School Counselor/Office, or mail to the Community Scholarship Committee, Box 541, Claflin, Kansas 67525. Please return by April 1st, 2017. How long have you known the applicant?___________________________________________ In what relationship have you known the applicant (i.e. teacher, counselor, administrator, employer, friend)?________________________________________________________ What do you consider the applicant’s strongest characteristics and why?
What traits does the applicant have that might impact his/her success in post-secondary education?
Please rate the applicant in the following areas using the ratings: Excellent, Very Good, Good, Fair, Poor, or Not Applicable. Scholarship in your class(es)________________________________________________ Reliability/Dependablility__________________________________________________ Honesty________________________________________________________________ Motivation/Initiative______________________________________________________ Ability to Work With Others________________________________________________ Attendance______________________________________________________________ Ability to Start Tasks Promptly______________________________________________ Ability to Work Independently______________________________________________ Kindly give us further information that you have about this person that will help us to decide upon the applicant’s suitability for this scholarship. If additional space is necessary, the reverse side of this form may be used.
DATE_______________________
SIGNATURE_____________________________
President: Lois Steiner Secretary: Christina Hayes Treasurer: Cindy Stueder
NAME OF APPLICANT_________________________________________DATE__________ NAME OF PARENTS_________________________
ADDRESS_________________________
l. School activities and the years of participation (list them): example: FFA-2 years (A)
(E)
(B)
(F)
(C)
(G)
(D)
(H)
2. List awards or honors you have received while in school.
3. What elective offices have you held while in school? (A)
(E)
(B)
(F)
(C)
(G)
(D)
(H)
4. Church activities and the approximate hours of participation (list them): High School years only. (A)
(C)
(B)
(D)
5. Community/Volunteer activities and the approximate hours of participation (list them): High School years only (A)
(C)
(B)
(D)
6. List Work Experience Paid or Non-Paid & Responsibilities/Duties Involved (A)
(C)
(B)
(D)
7. Supply three letters of recommendation. (A) Current High School Teacher (Name
)
(B) High School Teacher or Paraprofessional (Includes Principal and Counselor) (Name ) (C) Employer or an individual other than a family member who is in a position to know you well. (Name ) The letters of recommendation are to be confidential. Envelopes should be prepared by the student applicant for those individuals writing letters of recommendation. Envelopes should be addressed and sent to Community Scholarship, Inc., Box 541, Claflin, Kansas 67525. 8. What career choices are you interested in?
9. List the college or vocational school of your choice. _________________________________________________________________________ 10. Why is this scholarship important to you?
11. What other scholarships and their amounts have been awarded to you at this time? (Scholarships Awarded will not be considered in awarding our scholarships)
12. What is the base cost of attendance of your first year of college? (Include Tuition, Books, Room and Board) $________________________________________________________________________ 13. How much will you be able to contribute towards this cost? $________________________________________________________________________ 14. Approximately how much money can you earn during the summer? $________________________________________________________________________ 15. What other financial help is available?
16. List other children in your family, including ages, who are still living at home or are full time college students.
17. Request the school counselor to send a transcript and ACT scores by April 1st, 2017 to Community Scholarship, Inc., Box 541, Claflin, Kansas 67525. 18. This application must be complete and postmarked by April 1st, 2017. Please mail to: Community Scholarship, Inc., Box 541, Claflin, Kansas 67525. 19. All letters of recommendation must be in the hands of the Community Scholarship Committee by April 1st, 2017. 20. You will meet with the scholarship committee at a time selected by you from posted times for a personal interview on April 30, 2017.
21. In the space below, explain fully, in your own handwriting, your objectives, ambitions, and tentative plans for the future.
I have read all qualifications for these scholarships and certify that all information included is true, to the best of my knowledge, and complete. Student
Date
Student's Cell Number
Student's e-mail (non- school)
*Applicant, please note that all monetary awards will be held until acknowledgement of thanks and proper notification of enrollment is received.
COMMUNITY SCHOLARSHIP RECOMMENDATION FORM CENTRAL PLAINS HIGH SCHOOL - CLAFLIN Applicant:____________________________________is applying for a Community Scholarship. Please give us your candid opinion of this applicant’s qualifications. All information will be kept confidential. Please place in an envelope and return to the Central Plains High School Counselor/Office, or mail to the Community Scholarship Committee, Box 541, Claflin, Kansas 67525. Please return by April 1st, 2017. How long have you known the applicant?___________________________________________ In what relationship have you known the applicant (i.e. teacher, counselor, administrator, employer, friend)?________________________________________________________ What do you consider the applicant’s strongest characteristics and why?
What traits does the applicant have that might impact his/her success in post-secondary education?
Please rate the applicant in the following areas using the ratings: Excellent, Very Good, Good, Fair, Poor, or Not Applicable. Scholarship in your class(es)________________________________________________ Reliability/Dependablility__________________________________________________ Honesty________________________________________________________________ Motivation/Initiative______________________________________________________ Ability to Work With Others________________________________________________ Attendance______________________________________________________________ Ability to Start Tasks Promptly______________________________________________ Ability to Work Independently______________________________________________ Kindly give us further information that you have about this person that will help us to decide upon the applicant’s suitability for this scholarship. If additional space is necessary, the reverse side of this form may be used.
DATE_______________________
SIGNATURE_____________________________
COMMUNITY SCHOLARSHIP RECOMMENDATION FORM CENTRAL PLAINS HIGH SCHOOL - CLAFLIN Applicant:____________________________________is applying for a Community Scholarship. Please give us your candid opinion of this applicant’s qualifications. All information will be kept confidential. Please place in an envelope and return to the Central Plains High School Counselor/Office, or mail to the Community Scholarship Committee, Box 541, Claflin, Kansas 67525. Please return by April 1st, 2017. How long have you known the applicant?___________________________________________ In what relationship have you known the applicant (i.e. teacher, counselor, administrator, employer, friend)?________________________________________________________ What do you consider the applicant’s strongest characteristics and why?
What traits does the applicant have that might impact his/her success in post-secondary education?
Please rate the applicant in the following areas using the ratings: Excellent, Very Good, Good, Fair, Poor, or Not Applicable. Scholarship in your class(es)________________________________________________ Reliability/Dependablility__________________________________________________ Honesty________________________________________________________________ Motivation/Initiative______________________________________________________ Ability to Work With Others________________________________________________ Attendance______________________________________________________________ Ability to Start Tasks Promptly______________________________________________ Ability to Work Independently______________________________________________ Kindly give us further information that you have about this person that will help us to decide upon the applicant’s suitability for this scholarship. If additional space is necessary, the reverse side of this form may be used.
DATE_______________________
SIGNATURE_____________________________
COMMUNITY SCHOLARSHIP RECOMMENDATION FORM CENTRAL PLAINS HIGH SCHOOL - CLAFLIN Applicant:____________________________________is applying for a Community Scholarship. Please give us your candid opinion of this applicant’s qualifications. All information will be kept confidential. Please place in an envelope and return to the Central Plains High School Counselor/Office, or mail to the Community Scholarship Committee, Box 541, Claflin, Kansas 67525. Please return by April 1st, 2017. How long have you known the applicant?___________________________________________ In what relationship have you known the applicant (i.e. teacher, counselor, administrator, employer, friend)?________________________________________________________ What do you consider the applicant’s strongest characteristics and why?
What traits does the applicant have that might impact his/her success in post-secondary education?
Please rate the applicant in the following areas using the ratings: Excellent, Very Good, Good, Fair, Poor, or Not Applicable. Scholarship in your class(es)________________________________________________ Reliability/Dependablility__________________________________________________ Honesty________________________________________________________________ Motivation/Initiative______________________________________________________ Ability to Work With Others________________________________________________ Attendance______________________________________________________________ Ability to Start Tasks Promptly______________________________________________ Ability to Work Independently______________________________________________ Kindly give us further information that you have about this person that will help us to decide upon the applicant’s suitability for this scholarship. If additional space is necessary, the reverse side of this form may be used.
DATE_______________________
SIGNATURE_____________________________
